| NPI | 1285993832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: TX T2724) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T2724) |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: TX T2724) | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2025-07-25 |